Paediatric obesity (Diabetes and Endocrinology)

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
    • Ketoacidosis in a person known to have diabetes with any of the following:
      • systemic symptoms (fever, lethargy) or
        vomiting or
      • inability to eat (even if not vomiting) or
      • abdominal pain or
      • headache
    • Refer to local HealthPathways or local guidelines
    • Use BMI charts to monitor growth.   Interpretation of BMI values in children and adolescents aged 2–18 years is based on sex-specific BMI percentile charts.  Ensure that the same chart is used over time to allow for consistent monitoring of growth
    • Growth of children less than 2 years of age is monitored using World Health Organization (WHO) growth charts. (Australian practice)
    • While waist circumference may not have a place in screening for overweight and obesity in children and adolescents, a waist circumference that is greater than half the height suggests a need for more thorough weight assessment.
    • Consider involvement of other professionals (e.g. aboriginal health worker, multicultural health worker, interpreter) to facilitate communication
    • In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment.
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
NB Refer to general paediatrics
  • Hypertensive >95% for age with appropriate size cuff (BP centile by age and height)
  • Type 2 diabetes
  • Severe obstruction in sleep with repeated arousals and distress
  • A child currently in out of home care (OOHC), or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service.
Category 2
(appointment within 90 calendar days)
NB Refer to general paediatrics
  • An underlying medical or endocrine cause is suspected, or there are concerns about height and growth velocity
  • Obese children <6 years
  • Other symptomatic obesity including obstructive sleep apnoea, hip or knee pain, high levels of psychological distress about weight
  • Signs of insulin resistance
Category 3
(appointment within 365 calendar days)
NB Refer to general paediatrics
  • Obese children > 6 years

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Current height and weight, including date of measurement
  • Blood pressure
  • Report presence or absence of concerning features:
    • Significant obstruction in sleep with repeated arousals and distress
    • Type 2 diabetes (random glucose > 11 or fasting >7.0) use diabetes CPC referral guide
    • Recent rapid change in weight (gain or loss)
    • Hypertension >95 centile for age with appropriate size cuff
  • Fasting glucose, insulin, ELFTs, FBC, iron studies, CRP, TFTs
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

Highly desirable information – may change triage category

  • History of obesity-related burden of disease – sleep disturbance, exercise limitation, orthopaedic pain, psychological disturbance
  • Height/weight/head circumference and growth charts with prior measurements if available
  • Diet history including if
    • the child has a very restricted diet, or specific dietary restrictions (refer to a dietitian)
    • extreme weight loss behaviours, signs of eating disorders, high level of negative body image and/or negative social experiences are evident (refer to psychological services)

Desirable Information - will assist at consultation

  • Assessment of parental obesity and other familiy history
  • Other past medical history
  • Pregnancy and birth history
  • Immunisation history
  • Developmental history
  • Medication history
  • Allergies
  • Significant psychosocial risk factors (esp. parents mental health, family violence, housing and financial stress, department of child safety involvement)
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Any other relevant laboratory results or medical imaging reports

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 2 December 2024

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